Online Program

Medicare market mechanism: The politics of a persistent idea

Monday, November 4, 2013 : 1:06 p.m. - 1:18 p.m.

Daniel Ehlke, PhD, MA, Department of Health Policy and Management, SUNY-Downstate Medical Center School of Public Health, Brooklyn, NY
Since 1972 and the opening of the program to managed care organizations, the application of market mechanisms within Medicare has enticed several generations of policymakers and political figures. This paper examines individual market programs, including Medicare managed care, the Part D drug benefit, as well as proposals to extend the role of the market within the context of the program, past and present. Despite the relative lack of evidence to suggest the effectiveness of many such programs (with a notable exception or two), market mechanisms continue to feature prominently in programmatic reform proposals. This paper will thus also explore just what makes market ideas so appealing to a range of policy actors, and therefore some of the factors that could go toward explaining their prevalence and longevity. Such a study is particularly significant in the wake of the release of the so-called 'Ryan plan' and its variants, which would transform Medicare from a program designed around the direct delivery of federal health benefits, to a premium support plan. While such dramatic reform programs were criticized by Democrats as well as many Republicans, they are simply the latest in a long line of market mechanisms--and will certainly not be the last of their ilk.

Learning Areas:

Administration, management, leadership
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Discuss the range of market mechanisms proposed and/or introduced within the context of the Medicare program. Evaluate the effectiveness of certain market-based programs within Medicare. Demonstrate the persistence of market mechanisms as they relate to Medicare, despite the paucity of evidence to support the assertion that they actually improve aspects of the program.

Keyword(s): Medicare/Medicaid, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have studied and taught on the policies and politics surrounding Medicare and other government programs for the past several years. My research has focused on recent reform episodes in the American and British health care systems. I have an interest in the balance struck between the conflicting values associated with citizenship and consumerism, and how this shapes the contours of specific national (and-sub-national reforms). I’m currently teaching on Healthcare Organization and Finance.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3208.0: Medicare/Medicaid Policy